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Research and Innovation
Pain Care Techniques
Children's pediatric cardiac surgeons perform many types of palliative (palliative comes from a Latin term meaning to reduce pain) surgery. Common palliative surgeries include:
In this procedure, pediatric cardiovascular surgeons increase the flow of blood to the lungs by inserting a tube that connects the aorta and the pulmonary artery.
This procedure helps patients with a single ventricle by allowing deoxygenated blood to flow into the lungs and avoid the heart. The one heart ventricle then pumps oxygenated blood.
Pulmonary artery banding
In this procedure, the flow of blood to the lungs is decreased by placing a band around the pulmonary artery.
In addition, the pain team - a multidisciplinary team of Children's professionals - works with Children's patients to help make them as comfortable as possible. Staff members have experience working with children of all ages, including medically fragile infants. The team also works with patients' families to help them confront serious prognoses and make the difficult decisions associated with complex care.
Grand Rounds on Cardiac-Related Topics
Anyone is welcome to view streaming video of Grand Rounds presentations at Children's Hospitals and Clinics of Minnesota. To view presentations or review a complete list of presentations, register through our Grand Rounds page.
The following presentations may be helpful to those with a special interest in pediatric cardiovascular care:
Hypoplastic Left Heart Syndrome: Improvements in Management and Outcomes, 2005
Francis X. Moga, MD
Pain Management in Children: Novel Routes of Application
Stefan J. Friedrichsdorf, MD
Missed Cardiac Diagnoses in the Newborn Nursery: Will Improved Screening Help?
N. Robert Payne, MD; David B. Gremmels, MD; Lee A. Pyles, MD
Symptom Management in Pediatric Palliative Care
Stefan J. Friedrichsdorf, MD
Twenty Year Experience with Hypoplastic Left Heart Syndrome
David Overman, MD
Diagnosing Congenital Heart Disease
David Gremmels, MD
Active Research and Publication
Principal Investigator: Amarjit Singh, MD, Pediatric Cardiologist
This study reviewed 20 years of treatment for patients with hypoplastic left heart syndrome (HLHS) at Children's Hospitals and Clinics of Minnesota and the Children's Heart Clinic. Patients studied were admitted to Children's of Minnesota with the diagnosis of HLHS since the treatment program's inception in 1985. Analysis by era in five-year increments (1985–1990; 1991–1995; 1996–2000; 2001–2005) was performed for demographics, election for surgical therapy, early and late outcomes, prenatal diagnosis, and anatomic and procedural
David Gremmels, MD, Pediatric Cardiologist
Respiratory syncytial virus (RSV) is common among young children during the winter. Most infants and young children become infected with RSV by age 3, developing a mild illness. However, because RSV can cause aggressive infection in the lower respiratory tract, it can be devastating for babies with congenital heart disease and premature infants. With compromised respiratory systems, these infants may be hospitalized or die from RSV infection. Children's of Minnesota is part of a multicenter trial testing MEDI-524 on infants with congenital heart disease. Starting
Overman, D. Cerebral Oximetric Monitoring of the Posterior Circulation in Neonates and Infants During Complete Aortic Arch Reconstruction. Status: Open.
If your child is undergoing a heart operation, it is likely that he/she will be placed on cardiopulmonary bypass during the surgery. Cardiopulmonary bypass allows the surgeon to operate on the heart and surrounding arteries while still providing blood flow to the brain and body. Typically, stickers with special sensors on them will be placed on your child's forehead. These sensors monitor whether or not the front part of the brain is receiving blood. However, less is known about how much blood the back of your child's brain is receiving. Candidates enrolled in the cerebral oximetric monitoring study have sensors placed on both the front and back of the patient's head. The purpose of the study is to determine:
- how accurate sensors are in recording blood flow to the back of the brain; and
- whether there are variations in blood flow to the back of the brain during cardiopulmonary bypass.
Overman, D. Optimal Management of Critical Left Ventricular Outflow Tract Obstruction: A Congenital Heart Surgeons' Society Study. Status: Open.
LVOTO, or left ventricular outflow tract obstruction, is a heart defect present in eight percent of babies born with heart defects. The LVOTO study is an observation study and does not involve the use of any experimental medications or treatments. Its aim is to collect large amounts of data on patients with LVOTO from a group of 75 dedicated heart surgeons at prestigious hospitals around North America. The purpose of the LVOTO study is to analyze which treatments are most beneficial and to provide doctors with detailed insight into to treating babies with this condition.
Overman, D. Pulmonary Conduit Study. Status: Open.
If your child is having a right ventricle-to-pulmonary artery conduit (RVPAC) installed to reconstruct your child's pulmonary outflow tract, your doctor may ask you to participate in the Pulmonary Conduit Study. The Pulmonary Conduit study is an observation study and does not involve the use of any experimental medications or treatments. Its aim is to collect large amounts of data on patients with LVOTO from a group of 75 dedicated heart surgeons at prestigious hospitals around North America. The purpose of this study is to determine which RVPAC options are most beneficial for which patients.
Perry, J. Conversion of hemodynamically stable atrial tachycardias in young patients with and without congenital heart disease. Status: Open.
This study is a retrospective chart review of all patients who received oral Sotalol therapy for acute conversion of atrial tachycardias. Sotalol is an oral, mixed isomer anti-arrhythmic agent in the U.S. An oral and IV form of d-sotalol is available in most of Europe. The oral preparation has shown promise for chronic control of a variety of arrhythmia substrates, including atrial tachycardias in young patients with and without congenital heart disease and the pharmacokinetics and pharmacodynamics of the drug are not well know. It has not been pursued as a therapeutic option for the acute termination of these arrhythmias. The purpose of this study is to determine whether a single oral Sotalol dose is a safe, effective means of terminating atrial tachyarrhythmias in young patients.
Snider, J. Pain Assessment and Management of the Post Surgical Adult Congenital Heart Patient in a PICU. Status: Open.
This study uses reviews of patients' charts to determine pain management practices in post-surgical adult congenital heart patients being treated in the Children's pediatric intensive care unit. Researchers will review documentation about patients' pain and treatments undertaken to resolve pain. This study is an observational study and does not involve the use of any experimental medications or treatments. The purpose of the study is:
- to determine the current practice nurses use in assessing and managing pain;
- to recommend an appropriate pain assessment tool, which has been validated for use in an adult critical care setting; and
- to develop a reference tool that can be used for educational purposes regarding pain assessment and management of the post-surgical adult congenital heart patient.
Gremmels D, Brook M, Silverman M, Tacy T. Accuracy of Coronary Artery Anatomy Using Two-Dimensional Echocardiography in d-Transposition of Great Arteries Utilizing a Two-Reviewer Method. Journal of American Society of Echocardiography, 2004, 17(5), 1064-63.
Gremmels, D, et al, Neurodeveopmental Outcome of Infants Supported with Extracorporeal Membrane Oxygenation After Cardiac Surgery. Pediatrics 2003, 111, 6(1), 671-675.
Gremmels, D. and Schaffer, M. Congestive Heart Failure. In: Berman, S, ed. Pediatrics Decision Making, 4th Edition. Philadelphia, PA: Mosby, 2003:62-66.
Gremmels, D. and Schaffer, M. Rheumatic Fever. In: Berman, S, ed. Pediatrics Decision Making, 4th Edition. Philadelphia, PA: Mosby, 2003:70-73.
Gremmels, D. and Schaffer, M. Supraventricular Tachycardia. In: Berman, S, ed. Pediatrics Decision Making, 4th Edition. Philadelphia, PA: Mosby, 2003:74-79.
Kuehne T, Moore P, Weber O, Martin A, Gleason K, Teitel D, Higgins CB. "Endovascular Stents in Pulmonary Valve and Artery in Swine: Feasibility Study of MR Imaging-Guided Deployment and Post-interventional Assessment. Radiology, 2003, 226(2), 475-481.
Kuehne T, Saeed M, Gleason K, Turner D, Teitel D, Higgins CB, Moore P. "Effects of Pulmonary Insufficiency on Biventricular Function in the Developing Heart of Growing Swine." Circulation, 2003, 104, 2363-2368.
Overman D, Sutton T, Moga F. "Transposition of the Great Arteries with Coexisting Sinus of Valsalva Aneurysm." Journal of Cardiac Surgery, 2005, 20(5), 469-471.
Amin Z, Overman D, Reddy M, Brown J. "Risk Factors in Fontan Palliation: A Multi-institutional Study." American Heart Association Annual Meeting. Orlando, FL, 2003.
Baker, C; "Heart Disease in Adolescents." Annual Katkov Tutorial. Minneapolis, MN, Jan. 2004.
Baker, C; "Heart Disease in Adolescents." Annual Katkov Tutorial. Minneapolis, MN, Nov. 2003.
Baker C. "Neonatal Interventional Procedures." North Memorial Hospital Pediatrics Department Lecture. Robbinsdale, MN, Feb. 2004.
Burton, D. "Sudden Death in Young in Athletes." University of Minnesota Sports Medicine Conference, Minneapolis, MN, March 2004.
Burton, D. "Sudden Death in Young in Athletes." Children's Grand Rounds, Minneapolis, MN, July 2004.
Gleason, K. "Fetal Diagnosis of Congenital Heart Disease." Minnesota Perinatal Conference, March 2004.
Gleason, K. "Fetal Diagnosis of Congenital Heart Disease." Minnesota Perinatal Conference, June 2004.
Gleason, K. "MRI evaluation in Congenital Heart Disease." Parents for Heart Conference, Minneapolis, MN, May 2004.
Gleason, K. "Rheumatic Fever Revisited." Annual Katkov Tutorial, Minneapolis, MN, Nov. 2003.
Gleason, K. "Rheumatic Fever Revisited." Annual Katkov Tutorial, Minneapolis, MN, Jan. 2004.
Gleason K, Lesser J et al. "Coronary CT Angiography in the Pediatric Patient Population Feasibility, Heart Rate Control, and Radiation Dose." World Congress of Pediatric Cardiology and Cardiac Surgery. Buenos Aires, Argentina. Sept.2005.
Gleason K , Nemec E, Lesser J. "Definitive Non-invasive Pediatric Coronary Artery Imaging: CTA as a Compliment to Echocardiography." World Congress of Pediatric Cardiology and Cardiac Surgery. Buenos Aires, Argentina. Sept. 2005.
Gremmels, D. "Echocardiography in Children." Annual Katkov Tutorial, Minneapolis, MN, Nov.2003.
Gremmels, D. "Echocardiography in Children." Annual Katkov Tutorial, Minneapolis, MN, Jan. 2004
Gremmels, D. "Risk Assessment in Young Athletes." St Mary's/Duluth Clinic Cardiovascular Symposium, Duluth, MN, May 2004.
Gremmels, D. "Syncope and Murmurs in Children." Fairview Northland Hospital Grand Rounds, Princeton, MN, June 2004.
Moga, FX, et al. "Univentricular heart defects and Trisomy 21: Results from the PCCC." World Congress of Pediatric Cardiology and Cardiac Surgery. Buenos Aires, Argentina. Sept. 2005.
Overman, D. "Progress in the Treatment of Single Ventricle: The Extra Cardiac Fontan." Hitchcock Surgical Society Annual Meeting, Minneapolis, MN, 2003
Overman, D. "Robotics in Congenital Heart Surgery." Hitchcock Surgical Society Annual Meeting, Minneapolis, MN, 2004.
Overman, D, Orton L, Moga F, Tessmer M, Cobb F, Finkelstein M, Hustead V, and the ELSO Registry. "Extracorporeal Membrane Oxygenation in the Post-Cardiotomy Patient: Outcomes of the Extracorporeal Life Support Organization (ELSO) Registry." Midwest Pediatric Cardiology Society Annual Meeting, Cleveland, OH, 2004.
Perry, J. "Catheter and Surgical Management of Arrhythmias in Young Adults with Congenital Heart Disease." San Diego EP Society Symposium, San Diego, CA, March 2004.
Perry, J. "Ventricular Synchronization and Biventricular Pacing in Congenital Heart Disease" and "Advances in Arrhythmia Mapping." Fourth International Pediatric Cardiovascular Symposium, San Diego, CA, October 2004.
Perry, J. "Electrophysiology and Ablation of Slowly Conducting Pathways: Mahaim and PJRT" and "Radiofrequency Ablation of AV Node Reentry Tachycardia." Third Annual Charleston Symposium on Interventional Pediatric Electrophysiology. Charleston, SC, May 2005.
Perry, J. "Ablation of AVRT and AVNRT in Patients with Congenital Heart Disease," "Dysautonomia Syndromes in the Young," and "Resynchronization Therapy Should Be Undertaken in Patients with Tetralogy of Fallot at the Time of Surgical Revision." Heart Rhythm Symposium, New Orleans, LA, May 2005.
Perry, J. "Ventricular Synchronization and Biventricular Pacing in Congenital Heart Disease." Pediatric Cardiac Surgery Symposium, San Diego, CA, October, 2005.
Perry, J. "Neonatal Arrhythmias." Sixth International Symposium on Pediatric Cardiac Intensive Care, Miami, FL, December, 2005.
Perry, J. "Biventricular Pacing in Adults with Congenital Heart Disease." Sixth International Symposium on Pediatric Cardiac Intensive Care, Miami, FL, December, 2005.
Perry, J. "Difficult Ablations: Adult Congenital Heart Disease." Heart Rhythm Society Scientific Sessions, Boston, MA, May 2006.
Perry, J. "Pediatric EP: Cases from the Wards." Heart Rhythm Society Scientific Sessions, Boston, MA, May 2006.
Perry, J. "Pediatric Electrophysiology." First Annual Pediatric Cardiology Board Review Course, Miami, FL, June 2006.
Perry, J. "Electrophysiology and Heart Failure." Second International Symposium on Heart Failure in the Child and Young Adult, Laguna Beach, CA, December 2006.
Sutton T. "Kawasaki Disease." Annual Katkov Tutorial, Minneapolis, MN, Nov. 2003.
Sutton T. "Kawasaki Disease." Annual Katkov Tutorial, Minneapolis, MN, Jan. 2004.
Wright, G. "Hypercholesterolemia in Children and Young Adults." Park Nicollet Pediatric Conference, May 2004.
Wright, G. "Hypercholesterolemia and Hyperlipidemia in Children and Young Adults." Children's Grand Rounds, Minneapolis, MN, Dec. 2004
Wright, G. "Marfan Syndrome." Annual Katkov Tutorial, Minneapolis, MN, Nov. 2003.
Wright, G. "Marfan Syndrome." Annual Katkov Tutorial, Minneapolis, MN, Jan. 2004.
Innovations in Care
Innovations in cardiovascular care have resulted in significant decreases in mortality and increased life expectancies for children with heart conditions. At Children's, we are committed to the constant pursuit of better care. Next-generation technologies and care techniques available in the cardiovascular program include:
- 3-D echocardiography with color Doppler
- Cardiac catheterization lab
- Child life program
- Electrophysiology studies
- Fetal diagnosis
- AGFA Heartlab™ system
- Integrative medicine program
- Minimally invasive procedures
- Pain care techniques
- Pediatric and Congenital Arrhythmia (PCA) Program
- Pediatric cardiac MRIs
- Surgical repair of hypoplastic left heart syndrome
Research and Innovation
At the heart of delivering next-generation care is Children's commitment to generating and applying new knowledge. This commitment is what helps make Children's cardiovascular program one of the top 10 in the U.S. with treatment results consistently among the best in the nation.
Our commitment to new knowledge includes:
Children's of Minnesota has a long history of contributions to pediatric research and a commitment to continue to define and deliver the next generation of care. This inaugural report describes Children's robust and growing research program, demonstrating the breadth and importance of this work.
Children's prioritizes research directions that can result in clinical benefits for children and their families. Children's team members publish research through peer-reviewed journals, books, and medical conferences.
Children's is committed to constantly evolving the pediatric cardiovascular program in pursuit of better outcomes for patients.